Provider Demographics
NPI:1245576123
Name:MCGOWN, MICHELLE LOUISE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOUISE
Last Name:MCGOWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 OLD BRYSON CITY RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:NC
Mailing Address - Zip Code:28789
Mailing Address - Country:US
Mailing Address - Phone:828-497-7374
Mailing Address - Fax:
Practice Address - Street 1:1471 OLD BRYSON CITY RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:NC
Practice Address - Zip Code:28789-8683
Practice Address - Country:US
Practice Address - Phone:828-497-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse